This project will develop and apply improved methods for estimating the incidence and costs of injury from alcohol. The current methods and estimates (Rice et al., 1990) are not defensible. This project will yield a better understanding of the injury consequences of alcohol, impacts these injuries have on society, and the potential to reduce them cost-effectively. It will provide both defensible estimates for 1989 and estimates usable for benefit-cost analysis of interventions aimed at reducing injuries attributable to alcohol. The project will produce the first national estimates of the number of "innocent" victims who are injured as a consequence of someone else's drinking. It also will make a systematic attempt to estimate which injuries involving alcohol are attributable to alcohol. The study will examine various approaches to attribution. It will compare cost and incidence estimates for attributable injury to the more commonly used, but methodologically questionable estimates for alcohol-related injuries. The question of who pays for injury from alcohol will be probed. Data about what they pay can help persuade employers and communities to support prevention and treatment. Both prevalence-based and incidence-based costs will be generated. The incidence-based costs will include estimates of willingness-to-pay to avoid the pain, suffering, and lost quality of life that result from injury. The analysis of nonfatal injury will compare injury incidence rates for alcohol-disordered people and demographically and locationally matched controls. Separate comparisons will be made for hospitalized injuries and injuries treated in emergency rooms. This analysis will use Medicare data and a data set that NIAAA recently purchased from Medstat Systems, Inc., which contains health care records for roughly 60,000 substance abusers under age 65. The effort will yield two bonuses: exposure data and health care records on a demographically matched control group for use with the NIAAA data, and Medicare hospital inpatient and emergency room records for a compatible sample of alcohol abusers and matched controls over age 65. The analysis of attribution and innocent victims will draw on literature review and analysis of Federal data bases about highway crashes. In addition, a search of Maryland medical examiners records will yield insight on these issues for fatalities. This search also will fill in knowledge gaps about alcohol- related injury frequency for some types of intentional injuries.